Healthcare Provider Details

I. General information

NPI: 1700935780
Provider Name (Legal Business Name): RUTLAND RADIOLOGISTS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 11/16/2022
Certification Date: 11/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 ALLEN ST
RUTLAND VT
05701-4560
US

IV. Provider business mailing address

PO BOX 440
RUTLAND VT
05702-0440
US

V. Phone/Fax

Practice location:
  • Phone: 802-775-7111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DANIEL RICHARD MITCHELL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 802-747-3650